Zisman et al developed equations for predicting the probability of survival in a patient following radical nephrectomy for renal cell carcinoma. This can be useful in patient counseling and selecting appropriate therapeutic interventions. The authors are from the University of California in Los Angeles.
There are 2 equations for predicting survival:
(1) for those without distant metastases (M0 in TNM classification)
(2) for those with distant metastases (M1)
Parameters in nonmetastatic disease (M0):
(1) ECOG performance status (see Chapter 1, Performance Measures and Quality of Life)
(2) Fuhrman nuclear grade
Parameters in distant metatastic disease (M1):
(1) number of symptoms at presentation
(2) Fuhrman nuclear grade
(3) immunotherapy
(4) presence of lymph node metastasis
(5) T stage
|
Parameter |
Finding |
Points |
|
ECOG performance status |
0 (asymptomatic) |
0 |
|
|
1 to 4 (symptomatic) |
1 |
|
Fuhrman grade (if nonmetastatic) |
1 |
1 |
|
|
2 |
2 |
|
|
3 |
3 |
|
|
4 |
4 |
|
Fuhrman grade (if metastatic) |
1 |
0 |
|
|
2 |
0 |
|
|
3 |
0 |
|
|
4 |
1 |
|
number of symptoms at presentation |
|
(number) |
|
immunotherapy |
not given |
0 |
|
|
given |
1 |
|
nodal metastasis |
none (N0) |
0 |
|
|
present |
1 |
|
T stage |
T1 |
0 |
|
|
T2 |
0 |
|
|
T3 |
1 |
|
|
T4 |
1 |
where:
• I used the point assignments in Table 4, page 1371. The hazard coefficients in this table are those used in the survival equations.
• Symptoms (from page 1370): hematuria, back or flank pain, abdominal pain, chest pain, anorexia, fever, night sweats, dyspnea, malaise or fatigue, patient detected palpable mass (flank mass or lymphadenopathy), chills. Weight loss was mentioned in the subsequent sentence.
|
Years of Survival |
Basic Survivorship Factor for Nonmetastatic (M0) |
Basic Survivorship Factor for Metastatic (M1) |
|
0.5 |
0.983 |
0.939 |
|
1 |
0.968 |
0.873 |
|
2 |
0.951 |
0.770 |
|
3 |
0.921 |
0.684 |
|
4 |
0.910 |
0.631 |
|
5 |
0.894 |
0.586 |
|
6 |
0.889 |
0.523 |
from Table 2, page 1370; M1 data based on patient with optimum findings.
X for nonmetastatic tumor =
= (1.09 * (points for ECOG performance)) + (0.57 * ((Fuhrman grade) – 1)) =
= (1.09 * (points for ECOG performance)) + (0.57 * (Fuhrman grade)) – 0.57
X for metastatic tumor =
= (0.49 * (points for Fuhrman grade)) + (0.48 * (points for T stage)) + (0.28 * (number of symptoms)) + (0.43 * (points for nodal status)) - (0.59 * (points for immunotherapy))
percent Y year survival for patient =
= 100% * ((basic survivorship factor for year Y) ^ (EXP(X)))
Purpose: To predict survival for a patient with renal cell carcinoma using the mathematical models of Zisman et al.
Specialty: Hematology Oncology, Surgery, general, Nephrology
Objective: severity, prognosis, stage
ICD-10: C64, C65,
